Healthcare Provider Details

I. General information

NPI: 1679312649
Provider Name (Legal Business Name): JESSICA LAUREN POUNDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 BROAD ST
WICHITA FALLS TX
76301-2219
US

IV. Provider business mailing address

4600 CASCADES DR
WICHITA FALLS TX
76310-2543
US

V. Phone/Fax

Practice location:
  • Phone: 940-500-4903
  • Fax: 940-500-4906
Mailing address:
  • Phone: 940-631-9967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number895206
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: